Personality disorders in unipolar depressed inpatients: is patient perceived social support related to depression progression?

Abstract

Background: Unipolar depression (UD) and personality disorders (PD) often co-occur, impacting the prognosis of both conditions. A practical approach to UD must include the assessment of comorbid PD. We evaluated the prevalence of PD clusters in depressed inpatients, the prevalence of patients with comorbid PD at different stages of UD (1 - prodromal phase; 2 - first major depressive episode; 3 - residual phase; 4 - recurrent/double depression; and 5 - chronic major depressive episode), and compared the levels of social support (SS) between depressed inpatients with and without comorbid PD.

Methods: Cross-sectional study with 150 inpatients diagnosed with UD with or without comorbid PD. We applied a staging model of UD for clinical staging. We used the Mini International Neuropsychiatric Interview instrument (MINI) to diagnose UD. The PD diagnosis was conducted through chart review and interviews using DSM-IV criteria. The Medical Outcomes Study's Social Support Scale (MOS-SSS) assessed levels of SS.

Results: From the 150 patients with UD included in the study, 59 (39%) had comorbid PD, of which 33 (55.93%) were from cluster B, 8 (13.55%) were from cluster C, and 18 (30.5%) were cases of PD Not Otherwise Specified (NOS). Stage 5 (chronic major depressive episode) had a reduced rate of comorbid PD. Stages 3 (residual phase) and 4 (recurrent/double depression) had higher rates of comorbid PD. Levels of SS were lower in the comorbid group (UD + PD), in the Affectionate [UD + PD = 3.75 (SD = 1.13); UD = 4.17 (SD = 0.89), p = 0.031] and Tangible [UD + PD = 3.43 (SD = 1.21); UD = 3.94 (SD = 1.00), p = 0.02] domains of MOS-SSS.

Conclusions: Cluster B was the most prevalent, and the most prevalent PD diagnosis was PD NOS. Comorbid PD is prevalent mainly in the residual and recurrent episode stages. Inpatients diagnosed with UD and comorbid PD have lower levels of SS compared to those without comorbid PD. These results have clinical implications, contributing to the awareness of the impact of comorbid PD and SS on the management of UD.